New Student Online Lesson Request Form www.SLOMusicLessons.com

Email Address

Your Name

Phone

What is your preferred way for SLO Music Lessons to contact you? What is your preferred way for SLO Music Lessons to contact you? Text E-mail Phone Call

What kind of lesson format are you looking for? What kind of lesson format are you looking for? Private 1 on 1 Lessons Small Group Lessons

Who will be taking these Lessons? Who will be taking these Lessons? Myself Someone Else

Name of student(s)

Names of students in your Self-Assembled Group

Which instruments are you interested in? Which instruments are you interested in? Guitar Violin Ukulele Mandolin Banjo Piano Upright Bass Electric Bass

Session Length Session Length 30 Minutes 45 Minutes 60 Minutes 75 Minutes or More

What day(s) of the week are you available? What day(s) of the week are you available? Mondays Tuesdays Wednesdays Thursdays Fridays

What time(s) are you available on Monday?

What time(s) are you available on Tuesday?

What time(s) are you available on Wednesday?

What time(s) are you available on Thursday?

What time(s) are you available on Friday?

OPTIONAL: Describe Any Previous Musical Experience

OPTIONAL: Fill in any specific Musical Goals or Questions you have

Gift Certificate(s) Gift Certificate(s) I am redeeming a Gift Certificate that was given to me I would like to purchase a Gift Certificate to give these lessons as a gift